Research Questions
The authors of the article researched the following questions to guide on data and provide solution to the statement of the problem.
- What is the level of American Health Care Services (AHCS) utilization?
- What are the perceptions of AHCS utilization in terms of barriers, facilitators, and knowledge?
- Which topics are the most popular in learning to improve the use of AHCS?
- What are the predictors of utilization of AHCS?
The questions helped in identifying need, predisposing and enabling factors that were obstacles to the utilization of healthcare services by the targeted immigrants in America, their attitude towards the services provided and their level of knowledge on the healthcare issues and programs.
Research Hypothesis
The following were the hypotheses developed to speculate the outcome of the study.
- Health insurance and English proficiency are strong predictors of utilization of AHCS among KAIs.
- English fluency, knowledge about how to use AHCS, gender and religion are related to utilization of health care services.
- Lack of health insurance, language barrier and high costs are barriers to AHCS utilization.
- Years of residence in the US do not have any direct effect on health care utilization but it has an indirect effect through health insurance among immigrants.
The study was to test the practicability of such possibilities as the factors that block the ultimate and equitable use of healthcare services provided in America among the KAIs.
Study Designs
A sample method was employed to collect data from 91 KAIs residing in Triangle area of North Carolina which involved 35 males and 56 females. The inclusion parameters to the study included Korean immigrant from South Korea, age 20 or older, able to speak Korean or English. However, these inclusion criteria were not whole inclusive as younger and North Koreans were not able to participate.
Face to face interviews were conducted using open ended questions and each lasted about 30 minutes. They covered questions on the needs for health educational programs, barriers and utilization of AHCS.
Bilingual structured questionnaires were also constructed in both English and Korean and conducted by trained nurses and staff. The tool considered the psychosocial and health care utilization factors to test the KAIs’ level of utilization of the AHCS. The possible findings and predictors were analyzed and explained using Andersen’s behavior model which considered all the factors influencing the utilization of healthcare services and cultural backgrounds of the immigrants (Andersen, 1995).
The data collected was then analyzed using the following variables:
- Predisposing factors which are individual characteristics that affect health care utilization. They included marital status, years of residence in America and competing life priorities. These involve the barriers that hinder AHCS utilization among the KAIs.
- Enabling factors which include personal resources like ability to cater for medical bills and level of insurance coverage.
- Factors which include individual perceived needs like sources of health related information.
- Utilization of Health care services. This involved testing on the frequency of visits to the doctor and level of utilization of the services.
Summary of the Univariate Findings
Table 1 describes the demographic characteristics of the participants due to its descriptive nature of data which provided one variable. From the data findings participants of the questionnaire were people of 27 to 83 years old and they had been residents of the U.S for an average of 16 years. 35.7% of the participants were satisfied with their sustainable level of income of $40,000 - $49,999 annually. 45% of the study participants do not communicate well in English while the other 55% do well. Only 40.9% were insured, but the uninsured KAI could not afford insurance because of the high and unaffordable premiums. 49.5% reported to have had chronic diseases like diabetes or hypertension while 44% took prescribed medications.
Summary of the Bivariate Findings
This table provided information on the level of utilization and knowledge of AHCS among the KAIs giving relationship between the variables. Minority of the study participants reported to have used the AHCS with 68.1% reporting very little usage. 42% of respondents have routine medical checkups. 60.5% of study participants reported to have lack of knowledge about AHCS, and 51.7% have knowledge deficient about health insurance.
Limitation to the Study Findings and Conclusions
With the aim of the study to find the level and perception of healthcare utilization, the need for educational programs related to health and predictors of utilization of AHCS among the KAIs living in Triangle area in NC, the results exposed that there is poor utilization of healthcare services as 40% of respondents have rarely visited a doctor. This is because of high cost of healthcare services with limited level of income among the KAIs, lack of insurance cover due to knowledge deficiency and length of stay in the U.S, insufficient knowledge about AHCS and insurance as well as language barrier considering that majority of respondents speak Korean fluently as opposed to the American doctors. This limits their utilization of the health services provided.
Majority of the participants reported to have gathered health information in churches and church members calling for a great need to develop special educational programs on disease management and prevention to provide knowledge on the health care system in the U.S. The lessons should cover both communicable and non-communicable diseases affecting the larger population. They can also be provided within the Korean churches to minimize the health disparities among the KAIs. Churches provide social support through networking among the members, preserve cultural identity and traditions, provide health education, emotional and spiritual support (Jo, 2010).
The study relied on a small sample which made both qualitative and quantitative results to complement each other difficult. The inclusion criteria to the study also limited the scope of conclusion and generalization of the results for KAIs living in other states. This calls for future research to integrate broader samples and designs to address the issues. They should cut across a larger region and address not only Korean immigrants but also other immigrants living in America. Since health and health related issues are universal, the study to come should consider Koreans of all ages not to eliminate the younger generations.
